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TheClaim Appeal and Denial Support add-on provides, for any claim edit, the actual sourcing for that edit. For coders, this means no more searching for code guidelines for claims appeal support. Additionally, for each code, this tool provides information from Optum360 Evaluation and Management Coding Advisor AND The Auditor’s Desk Reference books, as well as access to the new Optum Lynx E/M Coding tool. All of these features and content arm the coder with information to avoid denials and evidence for effective appeals.

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New — Optum360 Edge — Sourcing information brings credibility to each claim edit in the Physician Compliance Editor feature (EncoderPro.com Expert and Payer). Each “scrubbed” claim now has industry standard coding guidelines that explain the coding errors identified on the claim. This claim edit information is essential when providing evidence for claim appeals for nonpayment.

Optum360 Edge — Access to Optum360 Evaluation and Management code book data that is tied to each E/M code. This gives clarity to E/M coding which has been traditionally the most difficult and most often coded section of codes. Code E/M services at the right level and ensure that you have the most correct guidelines to support your E/M code selections.

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Content Experts

Ryan graduated from the University of Utah in healthcare administration and has worked for multiple commercial payer organizations in several different roles. Additionally, Ryan worked as a practice administrator for a physician clinic, where he implemented an EMR system and a fully electronic coding and code review process. For the past 10 years, Ryan has designed and managed medical coding data management systems, workers compensation rebilling systems and medical coding/fee schedule software.